Clinical Reimbursement

Compliance Auditing and Quality Analysis

  • Provide internal/remote auditing support for compliance and processes
  • Perform quality assurance, MDS compliance, and chart reviews
  • Ensure case mix and RUG utilization compliance
  • Perform quality measure analysis, including value based purchasing, QRPS, PBJ analysis

Third Party Payor Coverage Support

  • Provide Medicare and Medicaid advantage plan appeals support, from initial request to process completion
  • Provide RAC and ZPIC audit appeals support
  • Perform as an Expert witness in ALJ appeals

Clinical and Industry Training and Support

  • Perform ICD-10 training, auditing, and training of cross application
  • Provide clinical training, including nursing and physician documentation, and PDPM readiness training and ongoing support
  • Perform care plan and care area assessment training and support
  • Provide MDS, event and webinar training for MDS coordinator, staff and CNAs
  • Provide external resource support for regional team or MDS coordinators
  • Assist with initiating and implementation of policy and procedures
  • Provide support in survey readiness and corrective plan action
  • Assist with transparency and QAPI for survey